Article Text

Original research
Efficacy and safety of hyperbaric oxygen therapy for fibromyalgia: a systematic review and meta-analysis
  1. Xinxin Chen1,2,3,
  2. Jiuhong You1,2,3,
  3. Hui Ma1,2,3,
  4. Mei Zhou1,2,3,
  5. Cheng Huang1,2
  1. 1 Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
  2. 2 Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
  3. 3 School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
  1. Correspondence to Cheng Huang; chenghuang_scu{at}


Objective To investigate the efficacy and safety of hyperbaric oxygen therapy (HBOT) for fibromyalgia (FM).

Design A systematic review and meta-analysis.

Data sources PubMed, EMBASE, Cochrane Library, Web of Science, VIP (China Science and Technology Journal Database), CNKI (China National Knowledge Infrastructure) and WanFang database were searched from from inception to 22 October 2022.

Eligibility criteria We included clinical trials (randomised controlled and non-randomised controlled trials) of HBOT for FM.

Data extraction and synthesis Two researchers independently screened the literature, extracted data and evaluated the quality of the included studies, with disagreements resolved by a third researcher. The Cochrane Collaboration checklists and the Methodological Index for Non-randomised Studies were used to assess the risk of bias. Meta-analysis was performed by RevMan V.5.4.1 software. Random effect models were used for meta-analysis.

Results Nine studies were included in this review, with a total of 288 patients. For pain assessment, we combined the results of the Visual Analogue Scale and Widespread Pain Index. The results showed that HBOT could relieve the pain of FM patients compared with the control intervention (standardised mean difference=−1.56, 95% CI (−2.18 to –0.93), p<0.001, I 2=51%). Most included studies reported that HBOT ameliorated tender points, fatigue, multidimensional function, patient global and sleep disturbance in FM. Adverse events occurred in 44 of 185 patients (23.8%). Twelve patients (6.5%) withdrew because of adverse reactions. No serious adverse events or complications were observed.

Conclusions HBOT might have a positive effect in improving pain, tender points, fatigue, multidimensional function, patient global and sleep disturbance in FM, with reversible side effects. Low pressure (less than 2.0 atmospheric absolute) may be beneficial to reduce adverse events in FM. Further studies should be carried out to evaluate the optimal protocol of HBOT in FM.

PROSPERO registration number CRD42021282920.

  • Rheumatology
  • Rehabilitation medicine

Data availability statement

Data are available upon reasonable request.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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Data availability statement

Data are available upon reasonable request.

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  • XC and JY are joint first authors.

  • XC and JY contributed equally.

  • Contributors Conceptualisation: CH, XC, JY. Funding Acquisition: CH. Formal Analysis: XC. Investigation: CH. Writing-Original Draft Preparation: XC, JY, MZ, HM. Writing–Review & Editing: all the authors. Guarantor: CH. All the authors fulfill the ICMJE criteria for authorship.

  • Funding Key Research and Development Project of Sichuan Provincial Science and Technology Department (No. 2018SZ0082); 1·3·5 Project for Disciplines of excellence–Clinical Research Incubation Project, West China Hospital, Sichuan University (No. 2021HXFH063)

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.